Mitral valve repair

Abstract

Apparatus and methods are provided for use with a mitral valve of a heart of a subject. The apparatus includes a P1-anchor, a P2-anchor, and a P3-anchor, that are anchored to tissue in a vicinity of, respectively, P1, P2 and P3 segments of a posterior leaflet of the mitral valve, a tether being fixedly coupled to the P2-anchor, and slidably coupled to the P1 and P3 anchors. A cardiac-site anchor anchors the tether to an anchoring location that is at a cardiac site that is anterior and inferior to the posterior leaflet. Other embodiments are also described.

The invention claimed is: 
     
       1. A heart valve device comprising:
 a first anchor configured to be anchored to tissue at a first vicinity of a valve annulus of a heart; 
 a second anchor configured to be anchored to tissue at a second vicinity of the valve annulus of the heart; 
 a third anchor configured to be anchored to tissue at a vicinity of an apex of the heart; and 
 a tether coupled to the first, second, and third anchors, wherein a first segment of the tether slidably extends through the first anchor and through the third anchor and a second segment of the tether slidably extends through the second anchor and through the third anchor, wherein the first and second segments of the tether are configured to be tensioned toward the third anchor following anchoring of the first, second, and third anchors, the third anchor configured to secure the first and second segments of the tether in a tensioned state. 
 
     
     
       2. The device of  claim 1 , wherein the first, second, or third anchor comprises a clip. 
     
     
       3. The device of  claim 1 , wherein the first anchor is configured to be anchored at a vicinity of a P1 segment of a posterior leaflet of a mitral valve. 
     
     
       4. The device of  claim 1 , wherein the second anchor is configured to be anchored at a vicinity of a P3 segment of a posterior leaflet of a mitral valve. 
     
     
       5. The device of  claim 1 , wherein the third anchor is configured to anchor the tether to an anchoring location that is anterior and inferior to the posterior leaflet of a mitral valve. 
     
     
       6. The device of  claim 1 , wherein the third anchor is configured to be anchored to an inner surface of the heart. 
     
     
       7. The device of  claim 1 , wherein the third anchor is configured to be anchored to an outer surface of the heart. 
     
     
       8. The device of  claim 1 , wherein the device is configured to restore a saddle-shape to a heart valve annulus. 
     
     
       9. The device of  claim 1 , wherein the device is configured to reshape a left ventricle. 
     
     
       10. The device of  claim 1 , wherein the device is configured to be delivered via a transapical approach. 
     
     
       11. The device of  claim 1 , wherein the device is configured to be delivered via a transaortic approach. 
     
     
       12. The device of  claim 1 , further comprising a fourth anchor wherein the tether is fixedly coupled to the fourth anchor and slidably coupled to the other anchors. 
     
     
       13. The device of  claim 12 , wherein the fourth anchor is configured to be anchored to tissue at a third vicinity of the valve annulus of the heart. 
     
     
       14. The device of  claim 13 , wherein the first segment of the tether extends from the fourth anchor, slidably through the first anchor and through the third anchor and the second segment of the tether extends from the fourth anchor, slidably through the second anchor and through the third anchor. 
     
     
       15. A heart valve device comprising:
 a first anchor configured to be anchored to tissue at a first vicinity of a valve annulus of the heart; 
 a second anchor configured to be anchored to tissue at a second vicinity of the valve annulus of the heart; 
 a third anchor configured to be anchored to tissue at a third vicinity of the valve annulus of the heart; 
 a fourth anchor configured to be anchored to tissue at a vicinity of an apex of the heart; and 
 a tether fixedly coupled to the second anchor, wherein a first segment of the tether extends from the second anchor and slidably extends through the first anchor and through the fourth anchor and a second segment of the tether extends from the second anchor and slidably extends through the third anchor and through the fourth anchor, wherein the first and second segments of the tether are configured to be tensioned toward the fourth anchor following anchoring of the first, second, third, and fourth anchors, the fourth anchor configured to secure the first and second segments of the tether in a tensioned state. 
 
     
     
       16. The device of  claim 15 , wherein the first, second, third, or fourth anchor comprises a clip. 
     
     
       17. The device of  claim 15 , wherein the first anchor, the second anchor, and the third anchor are configured to be anchored at a vicinity of, respectively, P1, P2, and P3 segments of a posterior leaflet of a mitral valve. 
     
     
       18. The device of  claim 15 , wherein the fourth anchor is configured to anchor the tether to an anchoring location that is anterior and inferior to the posterior leaflet of a mitral valve. 
     
     
       19. The device of  claim 15 , wherein the fourth anchor is configured to be anchored to an inner surface of the heart. 
     
     
       20. The device of  claim 15 , wherein the fourth anchor is configured to be anchored to an outer surface of the heart.